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PERMIT <br /> i <br /> dry OF ORONO PERMIT TYPE: <br /> 2750 Kelley Parkway- P.O. Box 66 SEWER if WATER, <br /> Crystal Bay, Minnesota 55323 Permit Number: t}{7770, <br /> (612)473-7357 Date Issued: <br /> 02/27/96 <br /> SITE ADDRESS: <br /> 2B7�� THOROUGHBRED LA <br /> LSV <br /> P. I . N. -,'-- 04--117-23-11-0016 <br /> DESCRIPTION: <br /> NEW SEPTIC SYSTEM <br /> Sewer & Water Permit Type NEW SEPTIC SYSTE <br /> Sewer t-i Water Wc-r k Type RESIDENCE <br /> i <br /> REMARKS: <br /> FEE SUMMARY: <br /> BaseFee $100.00 <br /> j}.} /7 <br /> Surcharge <br /> ) t} <br /> ---------- <br /> Total Fee $100. 50 <br /> i <br /> CONTRACTOR: - Applicant, - OWNER: <br /> CLOVER HILL COMPANY INC: 57237155 TONY E I DEN CO <br /> BOX 226 2570 THOROUGHBRED LA <br /> SHAD'OPEE MN SS: 79 ORONO MN 553S6 <br /> (612) 723-7155 <br /> THE UNDERSIGNED HF,! EOY REQUE STS PERM I� TO ,I�t E k��t. n CEMENTS <br /> SPECIFIED AND AGREES TO tom. ALt, .Wil IPS �t I+�T .�C t�?L I` E ��, CITY �F t <br /> L_ ORONO ORDINANCES AND STATE s- �iINNE TA "SUI�LDING t�E" RE{ <br /> APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE e.0 <br />